Exam 4

Risk factors for schizophrenia

1. neurochemical 2. genetics 3. neuroanatomy 4. nongenetic risk factors

What is pseudoparkinsonism?

stiff, stooped posture, shuffling gait, drooling, tremors, pill rolling

Nihilistic

exaggerated belief in the futility of everything; may deny his own existence, believe he/she is literally dead

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

Antipsychotics (Alzheimer's)

for behavioral symptoms

Stages of Alzheimer's Disease: Mild

forgetfulness; possible depression denial may start to come in patient still able to work at this stage just gets confused sometimes and patient often is aware of this

A client prescribed a monoamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat a. avocado salad plate. b. fruit and cottage cheese plate. c. kielbasa and sauerkraut. d. liver and onion sandwich.

fruit and cottage cheese plate. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat, contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident. This information makes the other options incorrect.

Tricyclic antidepressants patient teaching

give at night due to sedation and sleepy side effect (especially for the elderly)

Tricyclic antidepressants contraindications

heart dysrhythmias narrow angle glaucoma history of seizures

Long term risks of Lithium

hypothyroidism impairment of kidney's ability to concentrate urine aka nephrogenic diabetes insipidus

A 72-year-old patient is hospitalized diagnosed with pneumonia and experiencing delirium. When the client points to the IV pole and screams, "Get him out of here! He's going to hurt me!", the nurse recognizes the response as a(n) a. hallucination. b. delusion. c. illusion. d. confabulation.

illusion. Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.

Sundown Syndrome

increased confusion in the evening hours

DSM-5 Criteria for Schizophrenia

Two (or more) of the following, each present for a significant portion of time during a 1-month period At least one of these must be #1, 2, or 3. 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms

Stages of Alzheimer's Disease: Moderate to Severe

Unable to identify familiar objects or people; advanced agnosia and apraxia; can become psychotic wandering, pacing starts here perseveration may start

A student nurse on the psychiatric unit expresses being uncomfortable about discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern? a. "I'm glad you are thinking that way. They may not have thought of suicide before, and we don't want to introduce that." b. "You are right; however, because of professional liability, we have to ask that question." c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." d. "If I were you, I'd ask the health provider to talk to the patient about that subject."

"Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? a. "That is a good observation. Depression does mostly strike people older than 50 years." b. "Depression is seen in people of all ages, from childhood to old age." c. "Depression is most often seen among the middle adult age group." d. "The age of onset for most depressive episodes is given as 18 years."

"Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern? a. "I understand" and allow the client to close the door. b. Keep the door open, but step to the side out of the client's view. c. Leave the client's room and wait outside in the hall. d. "For your safety I can be no more than an arm's length away."

"For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate. The correct statement reinforces the basic need for client safety. The other options fail to provide for the degree of client safety required

Which question asked by the nurse demonstrates attention to the primary concern of palliative care? a. "Has your pain medication been effective at keeping you comfortable"? b. "Do you want to receive your palliative care at home or in an institutional setting?" c. "Do you have a spiritual provider you want me to be contacted?" d. "Who will be your acting as your primary care provider?"

"Has your pain medication been effective at keeping you comfortable"? Excellent symptom management is a hallmark of palliative nursing. Assessing pain management would reflect such a concern. While the other options present appropriate assessment questions, they do not address the primary issue of palliative care

Which statements identify a client's progress through the stages of grief? Select all that apply. a. "He didn't die; I'm sure he will be found and be just fine." b. "I will never accept he's gone; I will never give up looking for him." c. "If they find him, I'll never doubt miracles again." d. "I'll never understand why he risked his life by hitchhiking at night." e. "Knowing he's gone makes me so sad."

"He didn't die; I'm sure he will be found and be just fine.", "If they find him, I'll never doubt miracles again.", "I'll never understand why he risked his life by hitchhiking at night.", "Knowing he's gone makes me so sad." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death.

A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? a. "I still pray and read my Bible every day." b. "My mother wants to move in with me, but I want to independent." c. "I still feel bad about my sister dying of cancer. I should have done more for her!" d. "I've heard others say that depression is a sign of weakness."

"I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment? a. "I know a lot of people care about me and want me to get better." b. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I think things will be better soon."

"I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which response should the nurse provide to this client statement? a. "You are safe here in the hospital; nothing bad will happen to you." b. "The voices are wrong about the hospital food. It is not contaminated." c. "I understand that the voices are very real to you, but I do not hear them." d. "Other people are eating the food, and nothing is happening to them."

"I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing. This is the only option that provides such support

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? a. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." b. "I will not take any over-the-counter medication while on the fluoxetine." c. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." d. "I will report increased thirst and urination to my provider."

"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be: a. "That will be fine. I'll have you sign our hospital release form." b. "Because we do not have a copy of durable power of attorney, we cannot release them to you." c. "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." d. "I would like to have your mother wear them. It will help her to be less confused or retain more of her orientation."

"I would like to have your mother wear them. It will help her to be less confused or retain more of her orientation." Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids. None of the other options support this client need.

Which statement would best show acceptance of a depressed, mute client? a. "I will be spending time with you each day to try to improve your mood." b. "I would like to sit with you for 15 minutes now and again this afternoon." c. "Each day we will spend time together to talk about things that are bothering you." d. "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

"I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

A client diagnosed with schizophrenia states to the nurse, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be: a. "You are having problems with your speech. You need to try harder to be clear." b. "You are confused. I will take you to your room to rest a while." c. "I will get you a prn medication for agitation." d. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

"I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on yourself, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes.

When a client diagnosed with paranoid schizophrenia tells the nurse, a. "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be: b. "You are safe here. This is a locked unit, and no one can get in." c. "I do not believe I understand the word volmers. Tell me more about them." d. "Why do you think someone or something is going to harm you?" e. "It must be frightening to think something is going to harm you."

"It must be frightening to think something is going to harm you." This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? a. "Let's look at what you just said, that you can 'never do anything right.'" b. "Tell me what things you think you are not able to do correctly." c. "Is this part of the reason you think no one likes you?" d. "That is the most unrealistic thing I have ever heard."

"Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

A cognitively impaired resident living at a long-term care unit has become unsteady when walking alone. The family is concerned about the potential for serious injury from falls and suggests that restraints be used. What is the nurse's best response to the family's request? a. "You will need to make your request to the physician at the planning meeting." b. "The federal government forbids the use of restraints on elderly residents." c. "Using restraints puts the resident at higher risk for serious injury, even death." d. "Immobilization will cause constipation and necessitates the use of enemas."

"Using restraints puts the resident at higher risk for serious injury, even death." This response would open the door to being able to explain the hazards of restraint use compared with the minor problems incurred when the client is unrestrained. None of the other options provides appropriate information regarding the use of restraints in this situation.

Highly lethal methods of suicide

1. guns 2. hangings 3. carbon monoxide poisoning 4. staging a car crash

Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia? a. "We always reprimand him whenever his behavior is bothersome." b. "We watch him closely for signs of illness associated with relapse." c. "We have taught him to use the bus so we do not have to drive him everywhere." d. "We give positive recognition to him whenever he does even simple things well."

"We always reprimand him whenever his behavior is bothersome." An important need of families caring for the severely and persistently mentally ill is psychoeducation to help them understand the disease process. Families need to be prepared to meet the many concerns related to safety, communication, medication compliance, and symptom management. Family interventions are now considered an evidence-based practice, with research showing improved outcomes of decreased relapses and rehospitalizations for clients whose families participate. The only negative approach to the client and his/her needs is reflected in the option that suggests reprimanding when bothersome.

Which assessment question best demonstrates the nurse's understanding of a dying client's needs? a. "What are your hopes for your final days?" b. "Have you completed a Living Will?" c. "Are you aware of the pain control options available?" d. "Do you have any concerns about paying for your end-of-life care?"

"What are your hopes for your final days?" Care of the dying is a nursing responsibility. The focus of this care needs to shift toward the question, "What do you hope for at the end of your life?" rather than managing the cost of medical care. Pain management and advance directives are only individual aspects of end of life care.

Assessment tools for Depression

-Beck Depression Inventory -Hamilton Depression Scale -Geriatric Depression Scale -Zung Depression Scale

Positive symptoms of schizophrenia

1. hallucinations 2. delusions 3. bizarre behavior 4. positive formal thought disorder and speech patterns

Risk factors for depression

1. history/prior episodes of depression 2. family history of depressive disorder 3. history of suicide attempts or family history of suicide 4. LGBT 5. female 6. <40 years old 7. postpartum period 8. chronic mental illness 9. no social support 10. negative, stressful life events 11. active alcohol/substance abuse 12. history of sexual abuse

Clinical manifestations of neuroleptic malignant syndrome

1. hyperthermia 2. hypertonicity of skeletal muscles: rigid diaphragm = can't breathe 3. mental changes 4. autonomic instability: increase pulse, blood pressure, respiratory rate, profuse sweating, pallor, dysphagia 5. lab abnormalities: increased CPK, WBCs, and LFTs, renal decline or failure

Atypical (2nd generation) antipsychotics adverse reactions

1. lower seizure threshold 2. neuroleptic malignant syndrome

Delirium nursing interventions

1. monitor neurological signs 2. orient to reality 3. short, simple phrases 4. have patient close to nurses station 5. use least restrictive method of restraint (one-on-one sitter before using restraints and meds)

Medical management for depression

1. medications 2. electroconvulsive therapy: requires informed consent, NPO (8 hours prior), medicate to dry secretions, general anesthetic and muscle paralyzing agent, oxygen, after care: assess, reorient, short term memory loss 3. phototherapy (Seasonal affective disorder): bright light therapy boxes 4. vagus nerve stimulation 5. rapid transcranial magnetic stimulation 6. deep brain stimulation

Evaluation of mood stabilizers

1-3 weeks for effect in mania, 4-6 weeks for effect in depression

Common causes of Delirium

1. medications: digitalis, anti-hypertensives, steroids, anticholinergics 2. infections: UTIs, pneumonia 3. surgery 4. pain, emotional stress

Clinical manifestations of anticholinergic effects

1. memory difficulties 2. confusion, delirium 3. photophobia 4. narrow-angle glaucoma 5. increased body temp, flushed face 6. dry mouth 7. not sweating 8. constipation 9. urinary retention 10. blurry vision/dilated pupils

Teaching for Lithium

1. Adequate fluid intake (3L/day) 2. Awareness of heavy sweating and need to replace fluids and electrolytes 3. Take with food or milk 4. Don't change salt intake 5. If fine tremor, eliminate caffeine. PCP may try beta blocker 6. Moderately restrict calories if weight gain problematic 7. Symptoms of toxicity 8. Not to suddenly stop medication

Extrapyramidal symptoms

1. Akathisia 2. Pseudoparkinsonism 3. Acute dystonia 4. Tardive dyskinesia

Alzheimer's disease assessment: Cardinal Signs

1. Amnesia or memory impairment 2. Aphasia 3. Apraxia 4. Agnosia 5. Disturbances in executive functioning

Alzheimer's disease assessment: Cognitive impairment

1. Amnesia: memory impairment 2. Aphasia: loss of language ability (written, spoken, etc) 3. Apraxia: loss of purposeful movement in the absence of motor or sensory impairment (affects functionality like getting dressed, making coffee, etc) 4. Agnosia: loss of sensory ability to recognize objects

Neurocognitive disorders: Three main categories

1. Delirium 2. Mild neurocognitive disorder 3. Major neurocognitive disorder

Alzheimer's disease assessment: Four Defense Behaviors

1. Denial: cover up 2. Confabulation: making up answers in unconscious attempt to maintain self-esteem 3. Perseveration: repetition of speech/phrases or behavior like unpacking repetitively 4. Avoidance of questions

Typical (1st generation) Antipsychotics adverse reactions

1. Extrapyramidal symptoms 2. agranulocytosis 3. lowered seizure threshold 4. neuroleptic malignant syndrome

Evaluation of treatment for bipolar

1. must know patient's target symptoms 2. vital signs stable 3. well hydrated/nourished 4. able to control his/her own behavior 5. sleep 4-6 hours/night 6. knowledge of disease and medication

Delirium assessment

1. Patient safety: prevent physical injuries and self harm 2. History and information gathering: from family and caregivers 3. Physical examination assessment: drug screening, labs, make sure TSH not elevated 4. Optimize comfort and orientation: glasses, hearing aids, clocks, calendars

Nursing assessment: Bipolar disorder

1. Physiological safety: hydration, cardiac status, sleep exhaustion 2. Danger to self/others: inappropriate sexual activity, uncontrolled spending/giving 3. Assist in assessment r/t other disorders 4. Knowledge of disorder, meds, support groups, and organizations

Interventions: Acute Phase (bipolar)

1. Self-Care for Nurses: expect that patient may be: out of control, use power plays with the staff, use splitting as a way to distract staff and to loosen staff limits 2. Limit Setting: the ability to contain or diminish unacceptable or inappropriate behavior in a positive, professional manner an interpersonal skill that maintains the self-esteem of all parties and establishes personal boundaries 3. Skills: assertive communication techniques detached concern consistency with behavioral expectations and consequences 4. Avoid: setting limits out of proportion to the situation colluding with splitting

Negative symptoms of schizophrenia

1. affective flattening 2. alogia 3. avolition, apathy 4. anhedonia, asociality 5. attention deficits

Atypical (2nd generation) antipsychotics side effects

1. anticholinergic effects 2. orthostasis 3. sedation 4. metabolic syndrome: weight gain, dyslipidemia, altered glucose metabolism (risk for diabetes, hypertension, atherosclerosis and increase in heart disease)

Typical (1st generation) Antipsychotics side effects

1. anticholinergic effects 2. orthostasis 3. sedation 4. photosensitivity 5. weight gain 6. interference with sexual function

Interventions after suicide crisis period

1. arrange to have the patient stay with family, friends, or in the hospital if the patient is highly suicidal 2. remove weapons and pills; activate social supports 3. encourage the patient to talk freely and discuss alternatives and to avoid decisions 4. contact family members, and arrange for crisis counseling 5. prescribe anti anxiety or antidepressant medications if needed (only a 1 to 3 day supply of meds should be given)

Interventions for a Structured and Safe Milieu (Bipolar)

1. decrease environmental stimuli: limit joking and noise 2. avoid competition: provide structured solitary activities with staff 3. protect patient from consequences of poor judgement

Clinical manifestations of akathisia

1. difficulty remaining seated 2. agitation 3. restlessness

Acute Phase (bipolar): Communication strategies

1. display a firm, calm approach 2. express short, concise explanations or statements 3. remain neutral 4. maintain consistency 5. conduct frequent staff meetings to agree on approach and limit setting 6. hear and act upon legitimate complaints 7. firmly redirect energy through distraction

Anticonvulsant Drugs for Mood Stabilization (Bipolar)

1. divalproex (Depakote) aka Valproic Acid: black box warning for hepatitis and pancreatitis, blood dyscrasias 2. carbamazepine (Tegretol): bone marrow suppression, monitor levels initially 3. lamotrigine (Lamictal): Stevens Johnson syndrome and aseptic meningitis (both rare but serious)

Nursing interventions for self injury behaviors

1. establish trust 2. be non judgemental 3. encourage communication 4. set limits on behavior to maintain safety 5. identify the function of the behavior and triggers for the behavior 6. teaching alternative coping and problem solving skills

Health teaching for depression

1. no fault diagnosis 2. their target symptoms and symptoms of suicide risk 3. medications: purpose, managing side effects, recognizing toxic effects, adherence; length of treatment 4. follow-up therapy 5. reduce impact of stressor through problem solving 6. aftercare facilities 7. relapse prevention 8. healthy living skills, routine 9. community resources

Outcomes/Goals: for suicidal patients

1. not harm self this shift 2. verbalize suicidal ideations and discuss these with nursing staff 3. verbalize a desire to live and three reasons for living 4. identify 3 support persons outside of hospital whom he/she will call before acting on suicide (safety plan) 5. verbalize intent to follow up with psychotherapy and adhere to psychopharmacological interventions 6. verbalize 3 things they plan to do with/in their life (future orientation)

Schizophrenia course of illness

1. prodromal: social isolation, magical thinking, no hallucinations 2. acute: full effects of illness seen 3. stabilization: meds, therapeutic communication 4. maintenance: medications

Clinical manifestations of tardive dyskinesia

1. puckering 2. chewing movements 3. involuntary movement of the extremities

All antidepressant medications

1. require several weeks for full effect 2. have black box warning for suicide risk in children and adolescents 3. have discontinuation syndrome: gradually wean 4. avoid hazardous activities due to sedation side effect 5. avoid alcohol 6. safety during pregnancy is a concern 7. wash out period between trying different antidepressants 8. adverse effects: serotonin syndrome 9. start low, go slow

Assessment guidelines for Depression

1. risk of self harm or harm to others? 2. medical issues? 3. history of depression? 4. support systems? 5. precipitating events? 6. psychosocial assessment 7. self care 8. realistic expectations of self and of patient 9. identify source of feelings of depression

Clinical manifestations of pseudoparkinsonism

1. shuffling gait 2. rigidity: increased muscle tone of a uniform general nature 3. cogwheeling: uniform steady resistance to passive movements of the limbs 4. drooling 5. pill rolling

Lower risk methods of suicide

1. slitting wrists 2. inhale natural gas 3. ingesting pills

Treatment of Serotonin Syndrome includes:

1. stop the serotonergic drug 2. supportive/symptomatic: control hyperthermia (cooling blankets; chlorpromazine for hyperthermia), treat muscle rigidity, agitation, and seizure like movements with: klonopin (clonazepam), cogentin (benztropine), ativan (lorazepam); anticonvulsants for seizures; serotonin receptor blockade: cyproheptadine, methysergide, propranolol

Comorbid considerations associated with schizophrenia

1. substance use 2. tobacco use 3. depression 4. suicide 5. obesity 6. cardiovascular disease 7. diabetes 8. HIV

Cultural considerations for schizophrenia

1. symptoms more severe in industrialized nations 2. content of delusions and hallucinations may be different in different cultures

Interventions during suicide crisis period

1. therapeutic communication 2. be aware of times when patient is at increased risk (energy levels up following med therapy, following upsetting interpersonal interactions, prior to discharge or when changing observation levels) 3. ensure patient swallows all medications 4. no suicide contract vs. safety plan 5. build self-esteem

Tricyclic antidepressants when do you see the effects

10 to 14 days for initial effect and 4-8 weeks for full effect

Continuation phase (bipolar)

2-6 months Goal: relapse prevention Knowledge of disease process Knowledge of meds Early signs of relapse Consequences of substance addiction in relation to relapse

Serious mental illness (SMI) affects how many adults in the United States? a. 11 million b. 8 million c. 4 million d. 1 million

4 million SMI affects about 10 million adults in the United States. The other options are incorrect percentages.

Which statement factually describes the act of suicide? a. More women than men commit suicide. b. The Jewish culture has the lowest suicide rate. c. Suicide is the leading cause of death in the United States. d. A client diagnosed with schizophrenia is at great risk for attempting suicide.

A client diagnosed with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 8 times more likely to attempt suicide than is the general public. Suicide is the tenth leading cause of death in the United States. Protestants and the Jewish culture have a higher rate of suicide than do Catholics. More women attempt suicide, but more men are successful.

Based on the current research, which patient is most likely to develop dementia? a. An office manager in a high-stress environment b. A former boxer and is now a trainer c. A worker in a factory where asbestos is found d. A bartender in a dark underground club/bar

A former boxer and is now a trainer Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.

Which is the greatest protective factor against the risk of suicide? a. One or more previous suicide attempts b. A sense of responsibility to family c. Fear of dying d. A cultural belief that suicide is a shameful resolution for a dilemma

A sense of responsibility to family Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor. Previous attempts are a high risk factor. None of the remaining options have the impact that support has on preventing suicide.

Which room placement would be best for a client experiencing a manic episode? a. A shared room with a client with dementia b. A single room near the unit activities area c. A single room near the nurses' station d. A shared room away from the unit entrance

A single room near the nurses' station The room placement that provides a non stimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.

The term dual diagnosis refers to having a severe mental illness and what other dysfunctional behavior? a. A substance abuse problem b. Medication noncompliance c. A personality disorder d. HIV infection

A substance abuse problem Dual diagnosis is the term used to identify a client with severe mental illness and a substance abuse problem. Both problems must be treated if the client is to be successfully rehabilitated. None of the other options reflect an accurate description of the term dual diagnosis.

What is the first-line drug used to treat mania? a. Lithium carbonate b. Carbamazepine c. Lamotrigine d. Clonazepam

Lithium carbonate Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder

A client diagnosed with osteoarthritis says she is unable to sleep because of aching in her hips and shoulders. Which medication would be appropriate in this situation? a. Aspirin b. Meperidine c. Acetaminophen d. A sedative-hypnotic

Acetaminophen Acetaminophen is an effective analgesic in the elderly. It does not produce the gastrointestinal bleeding seen with aspirin and nonsteroidal anti-inflammatory drugs. Meperidine, an opiate with metabolites that stimulate the central nervous system, may produce confusion. A sedative-hypnotic may produce daytime sedation or confusion.

The nurse caring for a client diagnosed with Alzheimer's disease can anticipate that the family will need information about which medication therapy? a. Antihypertensives b. Benzodiazepines c. Immunosuppressants d. Acetylcholinesterase inhibitors

Acetylcholinesterase inhibitors Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine

Planning-Phases of Mania

Acute phase: medical stabilization, maintaining safety, self-care needs Continuation phase: maintaining medication adherence, psychoeducational teaching, referrals Maintenance phase: preventing relapse

Self Injury behavior assessment: Is there a chronic, repetitive pattern and potential lethality?

Frequent, chronic high rate pattern

A client who lives with a daughter's family is often left alone during the day and even some evenings. The client has expressed being lonely and socially isolated. Considering the situation, which support option is most appropriate? a. Partial hospitalization b. Nursing home admission c. Home health nursing care d. Adult day care

Adult day care In adult day care settings, older adults are cared for during the day and stay in a home environment at night. These programs are meant to provide a safe, supportive, and nonthreatening environment and fulfill a vital function for older adults and their families. The programs allow older adults to continue their present living arrangements and maintain their social ties to the community; they also relieve families of the burden of 24-hour-a-day care for older adult dependents. Partial hospitalization is recommended for ambulatory patients who do not need 24-hour nursing care but require and would benefit from intensive, structured psychiatric treatment. Nothing indicates that the patient needs skilled nursing home care at this time. Home health nurses generally visit patients in their home to see to medical needs and treatment. This option would not fulfill the need for social interaction.

Which issue should the nurse discuss when planning end-of-life care for a terminally ill client? Select all that apply. a. Advance directive planning b. Hospice admission c. Cost of needed services d. Symptom management e. Curative therapies

Advance directive planning, Hospice admission, Symptom management Patients often turn to their nurse for assistance in understanding how to make end-of-life decisions. Appropriate topics include advance directive planning, hospice admission, and symptom management including pain medication. The discussion of financial issues should be referred to social services or a personal finance advisor. Curative therapies are not considered when the client has been identified as having a terminal diagnosis.

Mild Neurocognitive Disorder (MCI)

Affects MEMORY but NOT their functions Does NOT interfere with general cognitive functioning Does NOT interfere with ADLs and socialization

An older adult client tells the nurse that he prefers not to attend senior citizens meetings because "they are all old fuddy duddies who talk subjects to death but never take action." The nurse can hypothesize that the client is demonstrating which type of reaction? a. Ageism b. Paranoid thinking c. Projection of personal weaknesses d. Poor social skills

Ageism Ageism, a form of discrimination, is often exhibited by the elderly themselves. Proximity raises feelings of vulnerability. None of the other options appropriately identifies this reaction.

You are working on a medical-surgical unit, and a peer is admitting a 71-year-old woman with a urinary tract infection. The nurse admitting an older, Hispanic, female adult for a possible urinary tract infection is overheard stating, "I probably won't be able to get accurate information until the client's family comes in and can answer my questions." The nurse is exhibiting which bias? a. Gender bias b. Ageism c. Racism d. Cultural bias

Ageism The nurse appears to be demonstrating discrimination against ageism by assuming she is confused or demented because of her age and will not be able to provide accurate information. Ageism has been defined as a bias against older people based on advanced age. Ageism differs from other forms of discrimination in that it cuts across gender, race, religion, and socioeconomic status to reach the majority of persons who are more than 65 years old. Gender is not a factor in this scenario. Neither race nor culture tends to be factors in this behavior

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess for which nightly behavior? a. Agitation b. Lethargy c. Depression d. Mania

Agitation Sundowning involves increased disorientation and agitation occurring at night. None of the other options are associated with sundowning

A client diagnosed with Alzheimer's disease looks confused and cannot recall many common household objects by name, such as a pencil or glass. The nurse should document this loss of function using which term? a. Apraxia b. Agnosia c. Aphasia d. Anhedonia

Agnosia Agnosia is a loss of the ability to recognize familiar objects. The loss is not associated with any of the other options.

A 78-year-old patient diagnosed with Alzheimer's disease picks up a glass from the bedside table but does not recognize the purpose of the object. This inability is associated with which characteristic of the disorder? a. Apraxia b. Agnosia c. Aphasia d. Agraphia

Agnosia Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.

A 68-year-old recently retired patient is referred to the mental health clinic for symptoms of depression, social isolation, and irritability. The client's son is with him and states, "My dad never used to be like this. My mom's been gone for 10 years and he has been doing fine." When the nurse asks the client directly about alcohol intake, he becomes defensive and refuses to discuss the issue. The nurse's response should be guided by what knowledge? : Select all that apply. a. Older men are more likely to abuse substances other than alcohol. b. Alcohol abuse often goes undetected in older adults. c. The client is exhibiting dysfunctional grieving. d. The client is most likely reacting to his retirement. e. Depression plays a role in increased drinking. f. Being single is a risk factor for alcohol abuse.

Alcohol abuse often goes undetected in older adults, Depression plays a role in increased drinking, Being single is a risk factor for alcohol abuse. The risk factors for heavy drinking in older adults are being male and single, having less than a high school education, low income, and smoking. Additionally, depression often plays a role in increased alcohol consumption in the elderly. Identifying alcohol and substance abuse is often difficult because the accompanying personality and behavioral changes associated with alcohol abuse frequently go unrecognized in older adults. Alcohol abuse is more common than is abuse of other substances. The patient's wife died 10 years ago, and there is nothing in the scenario to indicate dysfunctional grieving. Although depression may be a factor, the reasons for depression are not the priority assessment at this time.

Which type of dementia has a clear genetic link? a. Alcohol-induced dementia b. Multi-infarct dementia c. Creutzfeldt-Jakob disease d. Alzheimer's disease

Alzheimer's disease Family members of people with Alzheimer's disease have a higher risk of developing the disease than does the general population. Research does not support such a claim for any of the other options.

Tricyclics antidepressants: All Nurses Identify Client's Depression Treatments Daily

Amitriptyline Nortriptyline Imipramine Clomipramine Doxepin Trimipramine Desipramine

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? a. Amitriptyline is very expensive, so the patient may have to buy fewer at a time. b. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. c. The health care provider wants to see whether any side effects occur within the first week of administration. d. Amitriptyline is lethal in overdose.

Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

A 20-year-old Amish patient was diagnosed with paranoid schizophrenia 1 year ago who lives with his parents. When the nurse attempts to educate him about his diagnosis and the need for medication, the client persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to describe this response? a. Anosognosia b. Resistance c. Apathy d. Religiosity

Anosognosia Anosognosia is the inability to recognize one's deficits as a result of one's illness. In SMI, the brain, the organ one needs to have insight and make good decisions, is the organ that is diseased. An illness that makes one unable to recognize that illness can understandably cause one to be resistant to treatment. Although the patient may be resistant to treatment, it does not best describe the patient's denial of the illness. Apathy is lack of caring. Nothing in the scenario depicts the patient being preoccupied with religion at this time

Monoamine Oxidase Inhibitors (MAOIs): Not Popular Meds Educate

Nardil (phenelzine) Parnate (tranylcypromine) Marlpan (isocarboxazid) Eldepryl (selegiline)

Depression evaluation

Assess for resolution of target symptoms Effectiveness of therapeutic approaches Antidepressant effect: Tricyclics up to 10 days for effect, up to 8 weeks for full effect and SSRIs 2-4 weeks for full effect Drug levels: available for some tricyclic medications What level of support is needed to achieve goals: remember energy returns before mood improves, thus monitor for suicide risk!

Treatment for akathisia

Anticholinergic Benzodiazepines Beta blockers

Treatment for pseudoparkinsonism

Anticholinergics: -Benztropine (Cogentin) -Diphenhydramine (Benadryl)

Which form of grief involves concerns for the future? a. Disenfranchised b. Dysfunctional c. Anticipatory d. Maladaptive

Anticipatory Anticipatory grief or anticipatory mourning is when a future loss is being mourned in advance. None of the other options are associated with premature mourning for a loss that is likely to occur in the future.

Lithium drug interactions

Any drug that affects sodium levels may interact with lithium: Diuretics and low salt diet NSAIDS Aminophylline ACE inhibitors

A client who has been prescribed an antipsychotic medication comes to the clinic 3 days after his scheduled visit and demonstrates evidence of restlessness and agitation. He states, "My medicine ran out, and I didn't remember where to get more." The client's case manager should initially implement which intervention to support medication adherence? a. Arrange to have the client's nursing care plan reflect the need for a medication change b. Arrange for the client to see his psychiatrist as soon as the psychiatrist has an open appointment. c. Arrange for the client to get to the nearest emergency department for treatment. d. Arrange for a dose of the client's medication immediately.

Arrange for a dose of the client's medication immediately. The role of the case manager is to coordinate access to psychiatric treatment, housing, rehabilitation or work setting, socialization, and medical care. The client's immediate need for medication is best addressed by arranging for an immediate dose. None of the other options addresses the client's needs as effectively.

A client, who has been prescribed clozapine 6 weeks ago, reports flu like symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention? a. Suggest that the client take something for the fever and get extra rest. b. Advise the physician that the client should be admitted to the hospital. c. Arrange for the client to have blood drawn for a white blood cell count. d. Consider recommending a change of antipsychotic medication.

Arrange for the client to have blood drawn for a white blood cell count. Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flu like symptoms.

When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement? a. Being careful not to mention the idea of suicide. b. Listening carefully to see whether the client mentions suicide more overtly. c. Asking about the possibility of suicidal thoughts in a covert way. d. Asking the client directly if they are thinking of attempting suicide.

Asking the client directly if they are thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. None of the other options should direct this discussion.

A client who has recently received a terminal cancer diagnosis has expressed the desire to, "stay out of the hospital and die at home." Which nursing intervention will best help the client achieve this end-of-life goal? a. Involving the client and his/her family in treatment decisions b. Encouraging adherence to the medical treatment plan c. Discussing available pain control measures d. Assistance with advance care planning

Assistance with advance care planning Advance care planning has helped patients and their families achieve end-of-life goals, avoid hospitalization, and increase hospice and palliative care use. While the other options are appropriate interventions, none are as focused on assuring the client's end-of-life goals that are documented supporting their achievement.

Which intervention demonstrates the fulfillment of a moral duty a nurse has to a dying patient? a. Treating the client respectfully b. Advocating for the client's right to privacy c. Assuring the client has the information needed for informed consent d. Assisting the client in determining their preferences and goals for care

Assisting the client in determining their preferences and goals for care According to the American Nurses Association's Code of Ethics nurses have a moral duty to help patients determine these preferences and goals at the end of life. The remaining options relate to compliance with client rights.

Dysthymia cannot be diagnosed unless it has existed for what period of time? a. At least 3 months b. At least 6 months c. At least 1 year d. At least 2 years

At least 2 years Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period

Anxiolytics (Alzheimer's)

Benzos, my increase confusion

Treatment for dystonia

Benztropine, diphenhydramine

Treatment for anticholinergic effects

Bethanecol

Self Injury behavior assessment: What is the core problem?

Body alienation; exceptionally poor body image

The death of which terminal ill client, who self-administered a lethal dose of medication, resulted in the state of California adopting a Right to Die law? a. Terri Schiavo b. Jack Kevorkian c. Karen Anne Quinlan d. Brittany Maynard

Brittany Maynard Brittany Maynard was diagnosed with inoperable brain cancer in January of 2014. She and her husband moved from their home state of California to Oregon so that she could participate in Oregon's Death with Dignity Act. On November 1, 2014, Brittany self-administered a lethal dose of medication obtained under Oregon law. After Brittany's death, California Governor Jerry Brown signed a right to die bill into law. While all the other options identify individuals that played a role in the campaign to legalize physician-assisted suicide, none of their deaths resulted in California's adoption of a right to die law.

Atypical Antidepressants

Bupropion (Wellbutrin) Mirtazapine (Remeron) Trazodone (Desyrel)

Cognitive disturbances

Changes in mental function Delusions, hallucinations Illusions: visual perceptions of something that is real (example; see the real physically present IV tubing, but think it's a snake) Confusion, disorientation (confusion is NOT a normal part of aging)

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? a. Dark colored and modest b. Colorful and outlandish c. Compulsively neat and clean d. Ill-fitted and ragged

Colorful and outlandish Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance. None of the remaining options meet that criteria.

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? a. Constant 24-hour, one-to-one observation at arm's length b. One-to-one observation while client is awake c. Every 15-minute observation around the clock d. Seclusion with 15-minute observation

Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.

Bupropion (Wellbutrin)

Contraindicated in seizure disorder or traumatic brain injury: rate effect of decreasing seizure threshold Stimulating Can cause abnormal dreams so dose in AM Few sexual side effects Has less weight gain associated with it

The role of a case manager working with severely and persistently mentally ill clients who are homeless would include which intervention? a. Administer medication b. Coordinate needed services c. Ensure that the clients are not rehospitalized d. Teach the clients to function independently

Coordinate needed services Community mental health services are designed to provide outreach and case management for severely mentally ill persons who are homeless. A team approach is used to gain access to clients and connect them with the various services available to meet their needs. The role of the outreach worker is to be an advocate in all areas of client need and to foster client self-care. The role of the case manager does not include any of the other options.

The goal of a nurse working in psychiatric rehabilitation would be to help clients in the community achieve which outcome? a. Complete mental health b. Live comfortably in a psychiatric treatment facility c. Cope more effectively with their symptoms d. Learn to live with dependency

Cope more effectively with their symptoms The long-term outcomes of rehabilitation for severely mentally ill clients include the concepts of illness management and recovery. Illness management refers to the focus in the early stage of treatment that assists the client to gain control over symptoms. Clients are taught to collaborate with professionals in mental health treatment, reduce susceptibility to relapse, and cope more effectively with symptoms. Complete mental health is not always achievable.

What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? a. Bipolar II disorder. b. Bipolar I disorder. c. Cyclothymia. d. Seasonal affective disorder.

Cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.

The family members of a client with early-stage Alzheimer's disease cannot provide adequate supervision for the client. What would be a reasonable alternative for the nurse to explore with them to meet their current needs? a. Day care b. Acute care hospitalization c. Long-term institutionalization d. Group home residency

Day care Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions. The other options may be considered as the client moves into the advances stages of the disease disorder.

Bipolar disorder: Manic episode

DSM-5 criteria: Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week With 3 or more of the following: 1. inflated self-esteem or grandiosity 2. hyperverbal and pressured speech 3. flight of ideas or racing thoughts 4. distractibility 5. decreased need for sleep (feel rested after 3 horus) 6. increased goal directed activity or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences Impairment in occupational functioning or in social activities or relationships

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse should include information related to which local resources? Select all that apply. a. Day care centers b. Legal professionals c. Home health services d. Family support groups e. Professional counseling

Day care centers, Home health services, Family support groups, Professional counseling Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.

Attention Disturbances

Decrease attention span Sensitivity to light, sound, touch

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the patient and the family to recognize possible signs of impending mania? a. Increased appetite b. Decreased social interaction c. Increased attention to bodily functions d. Decreased sleep

Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with which cognitive disorder? a. Delirium b. Dementia c. Amnesic disorder d. Selective inattention

Delirium Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time. None of the other options share these characteristics.

Major Neurocognitive Disorder (Dementia)

Dementia is an umbrella term Onset: insidious-months to years Majority of dementias are irreversible; related to a primary encephalopathy: "Primary neurocognitive disorders" More than one cognitive domain is affected: multiple cognitive domains affected Interferes with the navigation of daily life

Which psychosocial disorder is more often initially seen in late life? Select all that apply. a. Depression b. Bipolar disorder c. Schizophrenia d. Dissociative disorder e. Anxiety

Depression and Anxiety Depression, risk for suicide, alcohol abuse, and anxiety are all disorders seen in mental illnesses in late life. Although it may be possible to experience these other disorders in older age, they are not usually first diagnosed in this age group; patients diagnosed with these disorders earlier in life may in fact have some symptom remission as they age.

A 62-year-old patient who is recovering from a urinary tract infection that has required hospitalized for delirium. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess regularly after discharge? a. Sleeping habits b. Sexual functioning c. Symptoms of posttraumatic stress d. Depression and level of cognition

Depression and level of cognition Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.

Suicide attempt assessment: What is the core problem?

Depression and/or rage about inescapable pain

What statement about the comorbidity of depression is accurate? a. Depression most often exists in an individual as a single entity. b. Depression is commonly seen in individuals with medical disorders. c. Substance abuse and depression are seldom seen as comorbid disorders. d. Depression may coexist with other disorders but is rarely seen with schizophrenia.

Depression is commonly seen in individuals with medical disorders. Depression commonly accompanies medical disorders. The other options are false statements.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of which feeling? a. Anger b. Disbelief c. Confusion d. Sympathy

Disbelief Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life." The statement doesn't demonstrate any of the other options as significantly.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? a. Reprimand the client by stating, "What an offensive thing to suggest!" b. Clarifying the nurse-client relationship by stating, "I don't have sex with clients." c. Distracting the client by suggesting, "It's time to work on your art project." d. Enforcing consequences by responding, "Let's walk down to the seclusion room."

Distracting the client by suggesting, "It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character for the client who truly has early stage Alzheimer's disease? Select all that apply. a. Easily frustrated by cognitive losses b. Charming behavior designed to hide memory deficit c. Confabulation to compensate for forgotten information d. Avoidance of questions by subject changing

Easily frustrated by cognitive losses, Frustration and anger are characteristics of the middle stage of Alzheimer's. During early-stage Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation. The remaining options are associated with the early stage of Alzheimer's disease.

Stages of Alzheimer's Disease: Late

End-stage: agraphia, hyperorality; hypermetamorphosis non ambulatory, bed-ridden hypermetamorphosis: want to touch everything hyperorality: put everything in mouth

Which of the following describe the symptoms of the manic phase of bipolar disorder? Select all that apply. a. Excessive energy b. Fatigue and increased sleep c. Low self-esteem d. Pressured speech e. Purposeless movement f. Racing thoughts g. Withdrawal from environment h. Distractibility

Excessive energy, Pressured speech, Purposeless movement, Racing thoughts, Distractibility All these options describe mania. The other options more aptly describe the opposite of what happens in mania.

A terminally ill, elderly client wants to ensure that his wishes about end-of-life care are followed and discusses them thoroughly with his daughter. Which action will best guarantee the client's wishes will be achieved? a. Share his wishes with the nurse b. Write a living will c. Issue a directive to his physician d. Execute a durable power of attorney for health care

Execute a durable power of attorney for health care With a durable power of attorney for health care, an individual designates a health care proxy who is informed of the client's wishes and is empowered to act on his or her behalf. No waiting period is required for the document to take effect. None of the other options would place the end of life care in the control of family as the correct option.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? a. Agreeing that this will help the client to remember the medications. b. Caution the client to drink several glasses of water daily. c. Suggest that the client also use a sun lamp daily. d. Explain the high possibility of an adverse reaction.

Explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

Clinical manifestations of dystonia

Eye manifestations: spasms of extraocular muscles Neck manifestations: torticollis Back manifestations: opisthotonus Pharyngeal muscle spasms or laryngospasm: can be life threatening

Delusions

False fixed ideas/belief: Persecution/paranoia Grandeur Ideas of Reference Thought broadcasting Thought insertion Thought withdrawal Nihilistic

A client diagnosed with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to which characteristic symptom of delirium? a. Anger b. Fear c. Unmet physical need d. Unmet social interaction

Fear Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation. Anger may develop but it is triggered by fear. Neither of the remaining options are generally associated with the behavior described.

Which side effects of lithium can be expected at therapeutic levels? a. Fine hand tremor and polyuria b. Nausea and thirst c. Coarse hand tremor and gastrointestinal upset d. Ataxia and hypotension

Fine hand tremor and polyuria The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.

Lithium Carbonate

First line agent for bipolar disorder Requires continuous treatment for prevention both of manic and depressive episodes Mechanism of action is unknown: acts like salt

What is the basic principle that is associated with hospice care? a. Family centered care b. Focus is on care not cure c. Treating client suffering d. Promoting client autonomy

Focus is on care not cure, Hospice is a multidisciplinary team approach that focuses on patient care, not cures. Palliative care is patient and family-centered care that optimizes quality of life anticipating, preventing, and treating suffering. Palliative care addresses physical, intellectual, emotional, social, and spiritual needs. Palliative caregivers promote patient autonomy, access to information, and choice. Hospice care incorporates many of the principles of palliative care.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nursing intervention? a. Interacting with a neutral attitude b. Using concrete language c. Giving multistep directions d. Providing nutritional supplements

Giving multistep directions The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times. Ineffective organizational skills would not be a primary factor considering the other options

Maintenance phase (bipolar)

Goal: prevent relapse Support groups Medication compliance psychotherapy

Delirium goal/evaluation

Goal: return to premorbid level of functioning

Which behavior would be characteristic of a client during a manic episode? a. Going rapidly from one activity to another b. Taking frequent rest periods and naps during the day c. Being unwilling to leave home to see other people d. Watching others intently and talking little

Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? a. Flight of ideas b. Distractibility c. Limit testing d. Grandiosity

Grandiosity Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.

A 31-year-old patient admitted with acute mania tells the staff and the other patients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? a. Unpredictability b. Rapid cycling c. Grandiosity d. Flight of ideas

Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes

The mother of a client with severe, persistent schizophrenia tells the nurse, "My son has slipped so far away from me over the past few years. We really don't have a relationship anymore. I miss him." The nursing diagnosis that best describes the mother's feelings using which term? a. Grieving b. Powerlessness c. Caregiver role strain d. Ineffective coping

Grieving The mother is mourning the loss of her son as she formerly knew him. Grief is a common experience for families with mentally ill members. The statement does not support any of the other options.

Typical (1st generation) Antipsychotics: Hal The Coughing Pirate Tried Three Full Meat Lover Pizzas (for schizophrenia)

Haloperidol Thiothixene Chlorpromazine Perphenazine Trifluoperazine Thioridazine Fluphenazine Molidone Loxaine Perphenazine

Unit practice requires inspection of all items being brought onto the unit by visitors. How can this be most effectively done? a. Having a staff member sit at the door and check packages as visitors enter. b. Having a staff member make frequent rounds during visiting hours to inspect gifts. c. Asking all visitors to report to the nurse's station before visiting a client. d. Asking clients to give staff any unsafe item that might have been left by a visitor.

Having a staff member sit at the door and check packages as visitors enter. A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety. None of the other options provide a measure of control before clients and visitors meet. Self-reporting by the visitors is not reliable.

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia in a 22-year-old male client? a. Excessive sleeping with disturbing dreams b. Hearing voices telling him to hurt his roommate c. Withdrawal from college because of failing grades d. Chaotic and dysfunctional relationships with his family and peers

Hearing voices telling him to hurt his roommate People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems

A client tells the nurse that he believes his situation is intolerable and is observed isolating socially. Which nursing diagnosis should be considered? a. Hopelessness b. Deficient knowledge c. Chronic low self-esteem d. Compromised family coping

Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness. The characteristics of the other options are not presented in the statement or behavior of the client.

Which statement by a young client who has severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? a. "I like to watch cartoons every morning." b. "I hear that marijuana helps calm you down." c. "I am looking for a job washing dishes at a diner." d. "I hate having my thoughts so messed up all the time."

I hear that marijuana helps calm you down." Clients with mental illness should receive information about the dangerous negative impact of using illegal drugs. None of the other options suggest situations that are unsafe for the client

What is the focus of the SAFE-T assessment tool? Select all that apply. a. Facilitate hospitalization. b. Identify level of suicidal risk. c. Development of client focused treatment. d. Introduce antidepressant medication therapy e. Stress collaboration with the client

Identify level of suicidal risk. Development of client focused treatment. Stress collaboration with the client. The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is an assessment tool that allows the clinician to benchmark relative risk (high, moderate, low) and to develop a treatment plan, in consultation with the patient, to reduce current risk. The tool does not provide for specific interventions

Planning: Alzheimer's Disease

Identify the level of functioning Gear the plan toward a person's immediate needs Assess the caregiver's needs: caregiver strain Plan and identify appropriate community resources Talk about realistic outcomes: end stage is death no matter what

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is experiencing what characteristic symptom? a. Hallucinations b. Illusion c. Hypervigilant d. Agnosia

Illusion Illusions are errors in the perception of a sensory stimulus. None of the other options are associated with this form of misperception.

Stages of Alzheimer's Disease: Moderate

Increased confusion; memory gaps; self-care gaps; apraxia; labile mood increased confusion sundowning, confabulation wandering apraxia: may appear disheveled because self-care ADL is affected labile mood; mood changes; socially withdrawn, easily frustrated cooking with stove becomes hazard: may leave it on; may need to disconnect stove driving becomes a hazard: call HCP and request that the physician bring it up to the patient; get creative take battery out of car, etc

Which assessment findings are associated with approaching death? Select all that apply. a. Increased drowsiness b. Increased blood pressure c. Progressive weakness d. Decreased heart rate e. Loss of appetite

Increased drowsiness, Progressive weakness, Loss of appetite The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure.

SAD PERSONS scale

Individuals risk for suicide Sex: female more likely to attempt; male more likely to chose more deadly means Age: 19-24 and > 65 most at risk Depression Previous attempts Ethanol and other drug use Rational thinking loss Social support lacking Organized plan: more specific = more risk No spouse Sickness

The clinical nurse specialist should suggest which cognitive intervention initially for a client experiencing auditory hallucinations? a. Seclusion when escalation begins b. Physical restraints when the client is disruptive c. Initiating a distracting technique d. Giving as-needed medication for anxiety

Initiating a distracting technique Strategies have been successfully applied to treat hallucinations, delusions, and negative symptoms, making cognitive interventions an evidence-based practice. For example, distraction techniques can be taught when auditory hallucinations occur, such as listening to music or humming. The remaining options should only be considered when less restrictive interventions, like distraction, prove to be ineffective and the client is at risk for injury to self or to others.

Which interventions and/or goals related to planning for discharge of a client diagnosed with a SMI would support the recovery model of care? a. Attending groups that teach how to cope with one's present illness. b. The client's parents will receive education on how to manage the patient's deficits. c. Care plan interventions will focus on medication adherence. d. Interventions will focus on the client's stated wish for independent living.

Interventions will focus on the client's stated wish for independent living. The recovery model is patient centered, instills hope and empowerment, emphasizes the person and the future, encourages independence and self-determination, and focuses on achieving goals of the patient's choosing and meaningful living. The National Alliance on Mental Illness (NAMI) and the President's New Freedom Commission on Mental Health (2003) both support the recovery model of care rather than the rehabilitation model, which focuses on the illness and the present. The other options all follow the rehabilitation model, focusing on the illness.

A usually quiet resident in a long-term care facility has become confused and has shouted out a number of times during the night. What is the nurse's initial action? a. Obtain an order for an as-needed dose of a sedative for the client. b. Encourage the client to be quiet and go back to sleep. c. Investigate the reason for the client's behavioral change. d. Place the client in a geriatric chair near the nurse's station.

Investigate the reason for the client's behavioral change. New-onset confusion and behavior change should not be treated with sedation, but rather should be investigated for the cause. Finding the cause and addressing it is more appropriate than using chemical restraint. Neither of the other options addresses the cause of the behavior

Bipolar illness

Is cyclical in nature Is chronic, recurrent and life-threatening illnesses Requires lifetime monitoring Specifiers: 1. rapid cycling bipolar disorder 2. mania or hypomania with mixed features

While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms? a. It is high risk, or a hard method. b. It is low risk, or a soft method. c. It was not an actual suicide attempt because the client was intoxicated. d. Considering the results, it is a nonlethal means.

It is high risk, or a hard method. Higher risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

What initial intervention should the nurse suggest to the family members of a client diagnosed with Alzheimer's disease who has become incontinence of urine? a. Label the bathroom door with a picture. b. Provide toileting on an as-needed basis. c. Apply disposable diapers. d. Encourage hourly toileting.

Label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are. The remaining options may need to be implemented eventually when such prompting is no longer effective.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? a. Self-blame b. Catatonia c. Learned helplessness d. Discounting positive attributes

Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings.

Mirtazapine (Remeron)

Less sexual side effects Sedating Side effects: abnormal dreams, confusion, influenza-like symptoms, hypotension

Side effects and adverse reactions of Lithium: LITHIUM

Leukocytosis: benign side effect Insipidus (Diabetic): large output of dilute urine, toxic; irritability of muscles (toxic) Tinnitus (toxic); tremor (fine=side effect; course=toxic) Hypotension (severe)=toxic Hyperexcitability of muscles (toxic) Increased weight (side effect) Incoordination=Ataxia (toxic) U Vomiting, nausea (side effect); vomiting and diarrhea (early toxicity) Miscellaneous: EEG changes, nystagmus, blurred vision, confusion (all toxic)

Hypertensive crisis

MAOIs block enzyme (monoamine oxidase) needed to metabolize norepinephrine, 5-HT, and dopamine thus increasing these neurotransmitters in synapse Monoamine oxidase also used to: break down tyramine and tryptophan in liver...if block MAO in the liver, get excess tyramine which results in hypertensive crisis First sign: severe headache Death can result from circulatory collapse or intracranial bleeding

Which statement best reflects the way clients who are severely and persistently mentally ill generally perceive how others in the community see them? a. Many feel stigmatized and alienated. b. Most feel under supported by family and friends. c. A large number are intensely hostile toward others. d. The majority are incapable of such self-reflective thought.

Many feel stigmatized and alienated. Studies have shown that many clients experience stigmatization, alienation, loss of relationships, and loss of vocational opportunities. While some clients may have the perceptions described in the other options, none are as generally expressed as feeling stigmatized and alienated.

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? a. Plastic plate b. Cloth napkin c. Styrofoam cup d. Metal utensils

Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays since metal utensils can be used to cause physical harm. None of the other options carry that same degree of risk

Self Injury behavior assessment: What was the level of physical damage and potential lethality?

Minimal physical damage and/of non-lethal means used

Nursing interventions for Alzheimer's

Monitor neurological signs Orient to reality: only when its early stage and won't cause distress Validation therapy: meet them where they are

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? a. Good memory and concentration b. Delusions of persecution c. Self-deprecatory ideation d. Sexual preoccupation

Self-deprecatory ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. This characteristic is not associated with any of the other options.

Medications for Bipolar

Mood stabilizers: 1. Lithium 2. Anticonvulsants: divalproex (Depakote) aka Valproic Acid, carbamazepine (Tegretol), and Lamotrigine (Lamictal)

Beck's cognitive theory suggests that the etiology of depression is related to what factor? a. Sleep abnormalities b. Serotonin circuit dysfunction c. Negative processing of information d. S belief that one has no control over outcomes

Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. None of the other options are related to this theory.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? a. Poor retention of recent events b. A weight loss from anorexia c. No pleasure from previously enjoyed activities d. Difficulty with tasks requiring fine motor skills

No pleasure from previously enjoyed activities Anhedonia is the only term that suggests the lack of ability to experience pleasure.

Which ethical concept regarding client care poses the greatest concern for a nurse providing end-of-life care for a client considering euthanasia? a. Nonmaleficence b. Beneficence c. Autonomy d. Individual liberty

Nonmaleficence An ethical concept relevant to euthanasia is that of nonmaleficence, or doing no harm and considering whether helping to end life is an act of harm. None of the other ethical concepts is as directly related to the actions of nursing at the end of a client's life.

Suicide attempt assessment: What was the level of physical damage and potential lethality?

Serious physical damage; lethal means of self-harm

Which statement is true of the relationship between SMI and substance abuse? a. Substance abuse rarely occurs within this population. b. Substance abuse occurs at approximately the same rate as in the general population. c. Of those diagnosed with SMI, substance abuse is high. d. Smoking has declined in this population at the same rate as the general public.

Of those diagnosed with SMI, substance abuse is high. Comorbid substance abuse occurs in 60% of those with SMI. It may be a form of self-medication, countering the dysphoria or other symptoms caused by illness or its treatment (e.g., the sedation caused by one's medications) or a maladaptive response to boredom. Nicotine use has always been higher in the population of those with SMI and is not declining as it has been in the general population. Substance abuse contributes to comorbid physical health problems, reduced quality of life, incarceration, relapse, and reduced effectiveness of medications. Substance abuse in those with SMI is higher than in the general population. Smoking has not declined in this population at the same rate as for the general public.

Atypical (2nd generation) antipsychotics: Old Airplanes Loop Right And Zip Past Quiet Cumulus Clouds (for schizophrenia)

Olanzapine Aripiprazole Lurasidone Risperidone Asenapine Ziprasidone Paliperidone Quetiapine Cariprazine Clozapine

A 69-year-old patient with a recent history of breast cancer is undergoing workup for memory loss. She asks the nurse, "Why am I having all these problems now? I thought life would get easier as I got older." The nurse's response should be guided by what knowledge? a. The client is an exception; older people usually have less medical and psychosocial issues than when younger. b. The client is exhibiting signs of acute depression. c. Older adults experience more medical and psychiatric illnesses. d. Older adults usually have a low risk for suicide.

Older adults experience more medical and psychiatric illnesses. Aging is accompanied by increased medical and psychiatric illness. This increase is brought about in part by increasingly stressful life events (e.g., the loss of a spouse, family members, and independence) and comorbid illness. Polypharmacy and drug reactions also play a part. There is nothing to indicate that the patient is depressed. The elderly population is at high risk for suicide.

Which suicide prevention intervention that has the greatest impact on a client's safety? a. Educating visitors about potentially dangerous gifts. b. Restricting the client from potentially dangerous areas of the unit. c. One-on-one observation by the staff. d. Removal of personal items that might prove harmful.

One-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm. While the remaining options provide some protection, none have the impact of constant supervision.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a. Onset of action is from 1 to 3 weeks or longer. b. They tend to be more effective for men. c. Recent memory impairment is commonly observed. d. They often cause the client to have diurnal variation.

Onset of action is from 1 to 3 weeks or longer. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

Delirium

Onset: acute - happens suddenly Transient; usually resolves in 4-6 weeks An emergency: must find out what is wrong that is causing it Always secondary to another issue Occurs more often in older adults and elderly

An elderly client is cognitively impaired and terminally ill with breast cancer. When asked if she is in pain, she usually denies it by shaking her head, but the nurses note that she lies rigidly in bed and grimaces when she turns from side to side. In an attempt to obtain a more accurate assessment, the nurses might choose to use the a. Present Pain Intensity Rating Scale. b. McGill Pain Questionnaire (MPQ). c. Wong-Baker FACES Scale. d. Pain Assessment in Advanced Dementia (PAINAD) scale.

Pain Assessment in Advanced Dementia (PAINAD) scale. The PAINAD scale is used to evaluate the presence and severity of pain in patients with advanced dementia who no longer have the ability to communicate verbally. The scale evaluates five domains: breathing, negative vocalizations, body language, and consolability. The score guides the caregiver in the appropriate pain intervention. None of the other options would compensate for this client's cognitive status.

Selective Serotonin Reuptake Inhibitors (SSRIs): Patient Feels Safe From Criticism Everyday

Paroxetine (paxil) Fluoxetine (Prozac) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro)

Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization? a. Anger and aggression b. Passivity and dependence c. Assertiveness and candor d. Fearfulness and paranoia

Passivity and dependence Medical paternalism, in which the health care provider made all decisions for patients with SMIs, was pervasive at the time of common institutionalization for mental illness. As a result, patients became dependent on the services and structure of institutions and unable to function independently outside such institutions. It was difficult to distinguish whether behaviors such as regression were the result of the illness or institutionalization. The other options are incorrect regarding the common resulting behavior of institutionalized patients.

The nurse is planning long-term goals for a 17-year-old male client recently diagnosed with schizophrenia. Which statement should serve as the basis for the goal-setting process? a. If treated quickly following diagnosis, schizophrenia can be cured. b. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. c. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. d. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

A student nurse is working with an 82-year-old patient diagnosed with dementia. The student is frustrated at times by not knowing how best to care for or communicate with the client. Which of the statement by the student best illustrates best care practice? a. Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" b. Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." c. Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." d. Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."

Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day." Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however, it is not the most effective care tool. The other responses are nontherapeutic.

Which document allows an individual to appoint another person to make health care-related decisions for them if they become unable to do so for themself? a. Advance directive b. Living will c. Do not resuscitate request d. Power of attorney for health care

Power of attorney for health care A medical or healthcare power of attorney is a document that lets you appoint someone you trust to make decisions about your medical care if you are unable to do so. An advance directive may include a living will, that may include the request not to resuscitate, and/or a power of attorney for health care.

C-SSRS

Presence of suicidal ideation or behavior based on protective factors and risk factors *suicidal ideation *intensity of ideation *suicidal and self injurious behavior

The term "perceptual disturbance" refers to difficulty in which area of function? a. Processing information about one's internal and external environment b. Can be one's way of thinking to accommodate new information c. Performing purposeful motor movements d. Formulating words appropriately

Processing information about one's internal and external environment Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. None of the other options are associated with this inability.

Interventions: Useful Activities for Alzheimer's

Provide picture magazines and children's books when reading ability diminishes Provide simple activities that exercise large muscles: walking, dancing Encourage group activities that are familiar and simple to perform Encourage physical activity during the day

Under the Patient Self-Determination Act of 1990, what is the nurse's responsibility when a client is admitted to a long-term care facility? a. Explain advance directives and the agency expectation that the client will formulate such directives within 24 hours after admission. b. Provide written materials concerning the client's rights to make decisions about medical care and to formulate advance directives and also ask whether the client has an advance directive. c. Offer to act as the client's health care proxy for as long as he or she is a resident at the facility. d. Ask the client to explain the end-of-life choices he or she has made and document these in the nursing progress notes.

Provide written materials concerning the client's rights to make decisions about medical care and to formulate advance directives and also ask whether the client has an advance directive. Any agency serving Medicare and Medicaid clients is obligated to provide written materials to all clients concerning their rights under state law to make decisions about medical care, including the right to accept or refuse surgical or medical care and to formulate advance directives. The nurse is required to ask whether the client has executed advance directives and to document it. This act does not address the actions identified in any of the remaining options.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? a. Senile dementia b. Hypertensive crisis c. Psychomotor agitation d. Central serotonin syndrome

Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. None of the other options are associated so directly with these behaviors

An assessment tool that is useful to nurses in rating suicide risk is the a. AIMS scale. b. SAFE-T. c. CAGE questionnaire. d. Mini-Mental Status Examination.

SAFE-T. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The SAFE-T is short and easy to use and is focused on the risk for self-injury. That is not the focus of the other options.

When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? a. Dyssynchronous b. Incongruent c. Cyclothymic d. Rapid cycling

Rapid cycling Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior

Suicide attempt assessment: Is there a chronic, repetitive pattern and potential lethality?

Rarely chronic repetition; some overdose repeatedly

The nurse working with a client diagnosed with severe and persistent mental illness will implement rehabilitation principles by concentrating on which intervention? a. Assessment on the client's deficits b. Reinforcing the client's strengths c. Reviewing earlier treatment plans for errors d. Considering the need to lower expectations periodically

Reinforcing the client's strengths Although deficits are assessed and addressed, implementation of rehabilitation is dependent on reinforcement of identified client strengths. Neither of the remaining options is fundamental to the rehab process.

Self Injury behavior assessment: What was the expressed and unexpressed intent?

Relief from unpleasant emotional pain (anger, tension, sadness, etc.)

Which of the following statements is true regarding culture and protective factors against suicide? a. Asian Americans have the highest rates of suicide. b. Religion and the importance of family are protective factors for Hispanic Americans. c. Older women have the highest risk for suicide among African Americans. d. American Indians and Pacific Islanders have the lowest rates of suicide.

Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

Secondary Dementia

Result of some other pathologic process: like AIDS related dementia or brain tumor that once removed reverses the dementia

Suicide assessment

Risk Ideation Behavior: past behavior is BEST prediction of future behavior Verbal and Behavioral clues: like giving stuff away, getting things in order

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? a. Risk for injury b. Ineffective role performance c. Risk for other-directed violence d. Impaired verbal communication

Risk for injury Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.

A teenaged client is being discharged from the psychiatric unit with a prescription for risperidone. The nurse providing medication teaching to the client's mother should provide which response when asked about the risk her son faces for extrapyramidal side effects (EPSs)? a. All antipsychotic medications have an equal chance of producing EPSs. b. Newer antipsychotic medications have a higher risk for EPSs. c.Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. d. Advise the mother to ask the provider to change the medication to clozapine instead of risperidone.

Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. Which is the most appropriate short-term goal for this diagnosis? a. Will reclaim any prized possessions that were given away. b. Be able to name three personal strengths. c. Seek help when feeling self-destructive. d. Consistently participate in a self-help group.

Seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal presented for Risk for self-directed violence since it focuses on client safety

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? a. γ-Amino-butyric acid b. Dopamine c. Serotonin d. Acetylcholine

Serotonin Low serotonin levels have been noted among individuals who have committed suicide. None of the other options are as directly related in the physiology of depression.

An issue for severely and persistently mentally ill clients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this problem? a. Discontinue antipsychotics that cause untoward side effects. b. Develop tools to predict relapse and assess the potential for violence. c. Shift follow-up from social workers to the ACT model. d. Use client empowerment techniques to increase client autonomy.

Shift follow-up from social workers to the ACT model. Adequate monitoring of medication effects by the community-based health care provider is often difficult but more achievable when the client is being monitored by the assertive community treatment (ACT) model. None of the other options present an effective remedy for this problem.

Cholinesterase inhibitors

Slow down progression of disease, does not cure it Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon) comes as a patch

Alzheimer's disease

Slow, insidious deterioration of the brain Cause is unknown Risk factors include: 1. Age 2. Diabetes, CV disease, HTN 3. Biological factors: neurofibrillary tangles, senile plaques, cerebral atrophy 4. Genetic Theory

A client diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis to address the client's concerns? a. Acute confusion b. Social isolation c. Risk for activity intolerance d. Impaired comfort

Social isolation Social isolation is aloneness experienced by the individual and perceived as imposed by others. None of the other options would be supported by the information provided in the question.

A client has reached the stable plateau phase of schizophrenia. What is the appropriate clinical planning focus for this client? a. Safety and crisis intervention b. Acute symptom stabilization c. Stress and vulnerability assessment d. Social, vocational, and self-care skills

Social, vocational, and self-care skills During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. All the other options should have been handled previously.

DSM-5 Symptoms of depression

Specific symptoms, at least 5 of these 9 , present nearly every day: 1. depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report or observation made by others 2. decreased interest or pleasure in most activities, most of each day 3. significant weight change (5%) or change in appetite 4. change in sleep: insomnia or hypersomnia 5. change in activity: psychomotor agitation or retardation 6. fatigue or loss of energy 7. guild/worthlessness: feelings of worthlessness or excessive or inappropriate guilt 8. concentration: diminished ability to think or concentrate, or indecisiveness 9. suicidality: thoughts of death or suicide, or has suicide plan

A client who lives with an adult child is quite self-sufficient but tells the community health nurse that "it gets lonely being by myself so much of the time with only the television set for company." What suggestion should the nurse make to address the client's need for socialization? a. Have the neighborhood watch visit once daily. b. Spend time at the local senior center three times a week. c. Attend an adult day health program daily. d. Attend a maintenance day care program daily.

Spend time at the local senior's center three times a week. A social day care gives the participants the opportunity for recreation and social interaction. Nursing, medical, or rehabilitative care is usually not provided. The client needs socialization but does not require other facets of care. The other options provide services that this client does not require.

Other treatments for depression

St. John's wort S-adenosylmethionine (SAMe) Peer support Exercise

A nurse planning continuing education programs for nursing staff members at a multipurpose senior center will plan programs based on the knowledge that which mental health problem is most common among the elderly? a. Schizophrenia b. Agoraphobia c. Obsessive-compulsive disorder d. Suicidal ideation

Suicidal ideation In the United States, the suicide rate among the elderly is the highest for any age group. While present among this population, none of the other options is considered a common disorder.

What is the major reason for the hospitalization of a depressed patient? a. Inability to go to work b. Suicidal ideation c. Loss of appetite d. Psychomotor agitation

Suicidal ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

SAFE-T

Suicide Assessment Five-step Evaluation and Triage ID risk factors ID protective factors Suicide inquiry Determine risk level/intervention Document

Which of the following is true of the relationship between bipolar disorder and suicide? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.

Non suicidal self injury behaviors

Superficial to moderate: -burning -cutting (different from being suicidal; releases endorphins so it is a way they feel good) -biting Severe: -head banging -castration -amputation -gouging

Severely mentally ill (SMI) clients often express a strong desire to be employed. According to the evidence-based research, what is the most effective model of employment for these clients? a. Vocational rehabilitation b. Productive employment c. A placement program of rehabilitation d. Supported employment

Supported employment In the past, vocational rehabilitation programs required extensive evaluation procedures and training before attempting job placement. However, these programs were unsuccessful at helping severely mentally ill clients to maintain jobs. Research efforts have identified a more productive model called supported employment.

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years old and Tara at 31 years old. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? a. Tara and Aaron have the same expectation of a poor long-term prognosis. b. Tara will experience more positive signs of schizophrenia such as hallucinations. c. Aaron will be more likely to hold a job and live a productive life. d. Tara has a better chance for positive outcomes because of later onset.

Tara has a better chance for positive outcomes because of later onset. Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? a. Schedule the client to attend group therapy that includes those who have relapsed. b. Teach the client and family about behaviors associated with relapse. c. Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse. d. Help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

Teach the client and family about behaviors associated with relapse. By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. None of the other options are effective interventions when considering relapse prevention.

Trazodone (Desyrel)

Technically is an antidepressant but not often used as one Dosage needed for antidepressant effect = high incidence of priapism Even at low doses it causes significant sedation Will see it prescribed a lot at night for depressed client who is having difficulty with sleep

Which factor will have the greatest impact on end-of-life nursing care in the coming decades? a. Technological advancements b. Decrease in federal funding for healthcare c. The aging of the Baby Boomers generation d. The decline in those entering the nursing profession

The aging of the Baby Boomers generation In 2014, the U.S. Census Bureau released a report projecting that the number of Americans over the age of 65 is expected to almost double from 43.1 million in 2012 to 83.7 million by 2050. Every day for the next 19 years, 10,000 baby boomers will be turning 65. This burgeoning sector of the population will place unprecedented strains on a health care system where health spending is growing faster than the overall economy. As this population experiences terminal illness, the need for end-of-life care will increase as well. While the other options are factors, the greatest impact will come from the existence of unprecedented numbers of terminal ill and dying clients

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a. a neologism. b. clang association. c. blocking. d. a delusion.

The answer is A. A neologism is a newly coined word that has meaning only for the client. None of the other options fit this description.

Currently what is understood to be the causation of schizophrenia? a. A combination of inherited and nongenetic factors b. Deficient amounts of the neurotransmitter dopamine c. Excessive amounts of the neurotransmitter serotonin d. Stress related and ineffective stress management skills

The answer is A. Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain

Which of the following would be assessed as a negative symptom of schizophrenia? a. Anhedonia b. Hostility c. Agitation d. Hallucinations

The answer is A. Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

The most common course of schizophrenia is an initial episode followed by what course of events? a. Recurrent acute exacerbations and deterioration b. Recurrent acute exacerbations c. Continuous deterioration d. Complete recovery

The answer is A. Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

Which side effect of antipsychotic medication is generally nonreversible? a. Anticholinergic effects b. Pseudoparkinsonism c. Dystonic reaction d. Tardive dyskinesia

The answer is D. Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The other side effects often appear early in therapy and can be minimized with treatment.

Schizophrenia is best characterized as presenting which personality trait? a. Split b. Multiple c. Ambivalent d. Deteriorating

The answer is D. The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? a. The client is getting better and is able to be assertive. b. The client may be at high risk for self-harm. c. The client is probably experiencing transference. d. The client may be angry at someone else and projecting that anger to staff.

The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

Ageism is best explained as what? a. A prominent personality disorganization after the age of 65 b. A learned helplessness among elderly clients c. The discrimination against the elderly on the basis of age d. The behaviors of elderly persons that serve as barriers to health

The discrimination against the elderly on the basis of age Ageism is a destructive phenomenon, based on negative attitudes toward the elderly, that results in age-related discrimination. None of the other options accurately describe this form of discrimination.

A terminally ill client expresses to the nurse the desire to discuss end-of-life issues. What is likely to be the greatest barrier to that discussion? a. The health provider's hesitancy to prescribe palliative care b. The client's lack of knowledge regarding the various issues c. The family's unwillingness to acknowledge the inevitable d. The nurse's reluctance to discuss death-related issues

The nurse's reluctance to discuss death-related issues Despite being trained to nonjudgmentally discuss difficult and sensitive issues with patients and families, nurses are often afraid to talk about death. Talking about death is difficult because of the emotions that are involved. While the other options may be factors, the nurse's attitude and willingness to engage in such a conversation initially have the greatest impact.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? a. No research exists to suggest genetic transmission. b. Much depends on the socioeconomic class of the individuals. c. Highly creative people tend toward development of the disorder. d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder.

The rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.

Lithium therapeutic range

Therapeutic blood level: 0.6 to 1.2 mEq/L Maintenance blood level: 0.4 to 1.0 mEq/L Toxic blood level: 1.5 to 2.0 mEq/L

A dying client's family is concerned that the opioid pain medication being prescribed will hasten the client's death. Why? a. The Rule of Double Effect (RDE) prevents the use of opioids to facilitate a client's death. b. There is little research evidence to support that appropriate opioid management will result in an earlier death. c. Pain management for the terminally ill is the primary concern of the health care team. d. Addition to the opioid is a greater risk than is the possibility of a premature death.

There is little research evidence to support that appropriate opioid management will result in an earlier death. Pain is sometimes undertreated because the patient and/or family is concerned about sedation, addiction, and/or hastening the demise of their loved one. The RDE is a bioethical principle that allows a physician or APRN to make a decision, such as prescribing adequate pain medication, even though the pain medication might cause the patient to die sooner. There is little evidence, however, to support the concern that appropriate use of opioids will hasten death.

Which statement about the adequacy of pain management in the elderly is supported by current research? a. They receive less analgesia than younger adults, which makes pain relief inadequate. b. They need smaller doses of pain medication to achieve adequate pain relief. c. They excrete analgesics more rapidly and therefore need more frequent doses. d. They respond better to meperidine than to morphine sulfate when opiates are necessary.

They receive less analgesia than younger adults, which makes pain relief inadequate. It is true that the older adult receives pain medication less frequently than younger adults resulting in ineffective pain management. None of the other statements are accurate.

Suicide attempt assessment: What was the expressed and unexpressed intent?

To escape pain; terminate life

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs)

Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) Levomilnacipran (Fetzima) Atomoxetine (Strattera)

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? a. Waiting quietly for the client to reply b. Prompting the client if the reply is slow c. Repeating the question if the client does not answer promptly d. Reviewing the client's medical record to support the client's response

Waiting quietly for the client to reply Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply

What are the most important characteristics for staff members who work with suicidal clients? a. Organization b. Problem-solving skills c. Warm, consistent interaction d. Effective interview and counseling skills

Warm, consistent interaction Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency since they support the nurse-client relationship. While helpful, none of the other options have the impact of a effective nurse-client relationship.

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)

Well tolerated Side effects: sexual dysfunction Most are still relatively new so we are still monitoring for adverse effects

Which event would an older client diagnosed with early stage Alzheimer's disease have greatest difficulty remembering? a. His or her high school graduation b. The births of his or her children c. The story of a teenage escapade d. What he or she ate for breakfast

What he or she ate for breakfast Initially, recent memory is impaired, and remote memory remains intact.

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? Select all that apply. a. How long the client has been suicidal b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan e. Has the client been suicidal in the past

Whether the plan has specific details, Whether the method is one that could cause death, Whether the client has the means to implement the plan Lethality refers to how deadly a plan is. The length of time a client has been suicidal or a history suicidal thoughts have nothing to do with the lethality of the plan. While the remaining options present important about the seriousness of the plan.

When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? a. With meals b. With an antacid c. 30 minutes before meals d. 2 hours after meals

With meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a. Withhold medication and notify the physician. b. Continue to administer medication as ordered. c. Advise the client to limit fluids for 12 hours. d. Advise the client to curtail salt intake for 24 hours.

Withhold medication and notify the physician. The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified. None of the other options are accurate interventions.

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? a. Writing in a diary b. Exercising in the gym c. Directing unit activities d. Orienting a new client to the unit

Writing in a diary Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.

Tardive dyskinesia

a permanent movement disorder characterized by: involuntary choreiform movements of the: mouth, tongue, face, and extremities

Akathisia

a subjective feeling or objective signs of muscle unrest, particularly in the lower extremities

Persecution/Paranoia

belief that one is being singled out or harmed by others those in power conspiring against the person, following them

Grandeur

belief that one is very powerful and important person, having special abilities, possessing great wealth or beauty

Thought broadcasting

belief that one's thoughts are broadcast directly from one's head to the external world

Thought insertion

belief that thoughts are being placed into one's mind by outside people or influences

Thought withdrawal

belief that thoughts have been removed from one's mind by an outside agency

Monoamine Oxidase Inhibitors (MAOIs): MOA

block enzyme (monoamine oxidase) needed to metabolize norepinephrine, 5-Ht, and dopamine thus increases these neurotransmitters in synapse

Tricyclic antidepressants MOA

block reuptake of norepinephrine and 5-HT, thus increasing availability in the synapse

Hyperactive delirium

can't sit still, restless psychomotor agitation

Bipolar disorder

characterized by moods that are at two opposite poles: depression and mania

Ruminating

continuously thinking about same thought

Cardiovascular effects of tricyclic antidepressants

dysrhythmias myocardial infarction heart block

Primary Dementia

irreversible progressive not secondary to any other disease

Survivors of suicide

may feel massive guild, have disturbed self concept, impotent rage with guild and blaming, search for meaning and feel denial

Major Neurocognitive Disorder (Dementia) causes changes in:

memory thinking learning comprehension executive planning and function motor ability social cognition language

Confabulation

memory gaps that your brain fills with something that makes sense

Ideas of reference

misconstruing trivial events and remarks and giving them personal significance

Serotonin syndrome

must be taking a drug that changes the body's serotonin level and have at least 3 of the following signs and symptoms: 1. mental status changes, such as confusion or agitation, or delirium 2. irrationality, mood swings, hostility 3. diarrhea or abdominal pain 4. heavy sweating not due to activity 5. fever: hyperpyrexia 6. tachycardia: cardiovascular shock 7. elevated BP 8. altered muscle tone: muscle spasms (myoclonus), overactive reflexes (hyperreflexia), shivering, tremor, tonic rigidity 9. uncoordinated movements 10. apnea: death

Autopsy

only way to make a definitive diagnosis of dementia

Monoamine Oxidase Inhibitors (MAOIs) side effects

orthostatic hypotension weight gain anticholinergic effects sexual dysfunction cardiac dysrhythmias avoid tyramine foods: can cause HYPERTENSIVE Crisis

Hypoactive delirium

patient quiet, withdrawn, apathetic

What is neuroleptic malignant syndrome?

rare, fatal complication of any antipsychotic

Contraindications of Lithium

renal, thyroid or neurological disorders cardiovascular disease pregnancy and breast feeding

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be a. risk for injury. b. acute confusion. c. imbalanced nutrition. d. impaired environmental interpretation syndrome.

risk for injury. Memory loss, agnosia, poor judgment, and the other symptoms of Alzheimer's disease contribute to placing the client at risk for injuries such as burns and falling down stairs. Risk for injury is always present for the client diagnosed with dementia. The remaining options suggest diagnoses that are associated with certain stages and degrees of cognitive impairment.

Primary concern with delirium

safety (physical always priority before psychological)

Selective Serotonin Reuptake Inhibitors (SSRIs): MOA

selectively blocks reuptake of 5-HT in synapse thus increasing available serotonin with less side effects

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to a. question the client's motive. b. set verbal limits. c. initiate physical confrontation. d. prepare the client for seclusion.

set verbal limits. Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of a. acute dystonia. b. tardive dyskinesia. c. cholestatic jaundice. d. pseudoparkinsonism.

tardive dyskinesia. An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia. This tool is not used to assess or monitor any of the other options

Schizophrenia spectrum disorder

thought disorder...lose ability to accurately perceive reality

Dystonia

tonic muscular contractions localized to one or several muscle groups: particularly in the eyes, mouth, throat, or neck